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General NPI Number Information
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NPI Number | 1144987025
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Entity Type | Organization
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Legal Business Name | POTOMAC SURGICAL ARTS,PC
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Dates
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Enumeration Date | 11/26/2021
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Last Update Date | 11/26/2021
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Provider Practice Location Address
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Address Line | 19440 GOLF VISTA PLAZA SUITE 130
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City | LANSDOWNE
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State | VA
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Zip | 20176-8264
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Country | US
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Telephone | 703-723-5366
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Fax | 703-723-5537
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Provider Business Mailing Address
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Address Line | 19440 GOLF VISTA PLZ STE 130
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City | LANSDOWNE
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State | VA
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Zip | 20176-8264
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Country | US
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Telephone | 571-239-8206
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | TRACEY BOYD
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Credential |
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Telephone | 703-723-5366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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